Incident Report Form

If you believe an Information Security Incident has occurred, please complete the following form and submit to abuse@purdue.edu. It is important to submit the form as soon as possible so that the incident response team can effectively address the incident. Many fields may not apply to a specific incident and in most cases not all of the information requested is available at the time a report is made. Please include all information available at the time of submission.

* Fields marked with an asterisk are required to submit the form.

Contact Information

* Name:

Department:

* Email Address:

Telephone Number:

Urgent

Affected Resources (please repeat this section for each resource affected)

Resource 1

IP Addresses and Hostnames:

Operating System:

Patch Level:

Resource Description (e.g. router, workstation, email server):

Incident Details

Type of Incident:

Date incident discovered:

Classification of data on machine(s) involved:

IMPORTANT NOTE REGARDING RESTRICTED AND/OR SENSITIVE DATA ON COMPROMISED MACHINE(S):

Unplug the Network Cable.
Do not unplug the machine from the power source! Keep the machine "powered on."
Finally … ensure that machine is located in a Secure Location, Step Away, complete this form in entirety and click Submit.

If known, list the hostnames and IP addresses of the source of the incident.

If unauthorized access occurred, please describe the method of intrusion if known.

Describe how the incident was discovered.

Describe any steps already taken to address the incident.

Describe the impact this incident has had on your department or organization.

Describe the current status of the incident. Is the activity ongoing?

Additional Details (e.g. email headers):